Parrish or Perish: Don't Shoot The Messenger

If you paid attention to last month’s WSDA News, you would have read that WSDA recently embarked on a challenge to Washington State to enforce its laws with regard to the prohibition of corporate practice, specifically RCW 18.32.675, Practice or solicitation by corporations prohibited. (1) No corporation shall practice dentistry.

There is increasing concern that there may be entities practicing dentistry in Washington that are not following this RCW to the letter of the law. Time will tell.

But that got me to thinking: what other laws are being routinely broken…by dentists? I am no lawyer, but there seems to me to be some areas where we can easily be questioned. I just had this goose and gander thought that gave me some pause. So let’s review some of the provisions of the law pertaining to us...and whether we dentists are following the law.

Let’s start off fairly simply: that framed version of your license:

RCW 18.32.190 Licenses display. Every person who engages in the practice of dentistry in this state shall cause his or her license to be, at all times, displayed in a conspicuous place, in his or her office wherein he or she shall practice such profession (emphasis added). So how far would I have to travel in your office to find it? The lab? Staff lounge? Your private office? The law says “conspicuous.” And that office where you are an associate two days a week?

My next concern is for East Overshoe Family, Laser, Sedation and Cosmetic Dentistry:

RCW 18.32.755 Advertising — Names used: Any advertisement or announcement for dental services must include for each office location advertised the names of all persons practicing dentistry at that office location. (emphasis added) I would venture to say this is probably the most violated of all laws pertaining to us. Your internet presence, that ad in your local East Overshoe Gazette, and the Alaska Airlines magazine ad — all require the names of all dentists practicing in your office. I’m lucky if I even see one name of the main proprietor.

Let’s examine your office signage:

WAC 246-817-400 Disclosure of provider services. A dentist who is personally present, operating as a dentist or personally overseeing the operations being performed in a dental office, over fifty percent of the time that such office is being operated, shall identify himself/herself in any representation to the public associated with such office or practice and shall provide readily visible signs designating his/her name at such respective office entrances or office buildings.

Any representation that omits such a listing of dentists is misleading, deceptive, or improper conduct. Dentists who are present or overseeing operations under this rule less than fifty percent of the time shall identify themselves to patients prior to services being initiated or rendered in any fashion. Every office shall have readily available a list of the names of dentists who are involved in such office less than fifty percent of the time. (emphasis added) So has that new associate who is there three days a week been added to your front door sign? You do have a “readily available…list” that includes the woman who practices there Friday and Saturday, right?

Don’t be tempted:

RCW 18.32.533 Unprofessional conduct — Abrogation of copayment provisions. It is unprofessional conduct under this chapter and chapter 18.130 RCW for a dentist to abrogate the copayment provisions of a contract by accepting the payment received from a third party payer as full payment.

I am relatively sure this was hashed out a number of years ago when it was more of a problem as it had become a favorite “practice builder” technique. Forget it; it’s fraud. Now I know how much you would like to defraud certain third parties, but don’t bother.

Your staff CPR all up to date?

WAC 246-817-720 Basic life support requirements. Dental staff providing direct patient care in an in-office or out-patient setting must hold a current and valid health care provider basic life support (BLS) certification.

Newly hired office staff providing direct patient care are required to obtain the required certification within forty-five days from the date hired. (emphasis added) Have you reviewed the list of lawful operations your hygienist can perform?

RCW 18.32.735 Unlawful practice — Hygienists. Any licensed dentist who shall permit any dental hygienist operating under his or her supervision to perform any operation required to be performed by a dentist under the provisions of this chapter shall be guilty of a misdemeanor.

WAC 246-817-550,560,570 contain the lists of procedures allowed under close and general supervision as well as prohibited ones under any circumstances. It is good to review them for all our staff members periodically as they do change. And we dentists often labor under misconceptions like, “a hygienist can’t use a high speed handpiece.” Best to review and be sure.

Finally, I will leave it to you to review WAC 246-817-460 Sexual misconduct on your own; it’s too titillating for a PG rated column. Subsection (1) lists a whole bunch of self-evident stuff that, if you ever did or attempted to do with/to a patient would be grounds for “throwing the book at you”. Don’t even go there; you just give our profession a whole lot of bad PR…and you will end up in jail with no license when you get out. Get some counseling NOW if it’s even a temptation.

It probably makes sense to periodically refresh your memory of what’s legal and what’s not. Go to / laws-and-regulations-1/ and check them out. There certainly are some that probably should be reviewed by DQAC and the state for practicality, but until they are changed, we are all subject to them. Many of these rules, including the prohibition against corporate practice, are there so patients and the public know who is responsible for the care rendered in any given facility; they are there for good reason.